title: How much colonoscopy screening should be recommended to individuals with various degrees of family history of colorectal cancer?
abstract: BACKGROUND
  Individuals with a family history of colorectal cancer (CRC) are at increased risk for CRC. Current screening recommendations for these individuals are based on expert opinion. The authors investigated optimal screening strategies for individuals with various degrees of family history of CRC based on a cost-effectiveness analysis.
  
  
  METHODS
  The MISCAN-Colon microsimulation model was used to estimate costs and effects of CRC screening strategies, varying by the age at which screening was started and stopped and by screening interval. The authors defined 4 risk groups, characterized by the number of affected first-degree relatives and their age at CRC diagnosis. For all risk groups, the optimal screening strategy had an incremental cost-effectiveness ratio of approximately $50,000 per life-year gained.
  
  
  RESULTS
  The optimal screening strategy for individuals with 1 first-degree relative diagnosed after age 50 years was 6 colonoscopies every 5 years starting at age 50 years, compared with 4 colonoscopies every 7 years starting at age 50 years for average risk individuals. The optimal strategy had 10 colonoscopies every 4 years for individuals with 1 first-degree relative diagnosed before age 50 years, 13 colonoscopies every 3 years for individuals with 2 or more first-degree relatives diagnosed after age 50 years, and 15 colonoscopies every 3 years for individuals with 2 or more first-degree relatives of whom at least 1 was diagnosed before age 50 years.
  
  
  CONCLUSIONS
  The optimal screening strategy varies considerably with the number of affected first-degree relatives and their age of diagnosis. Shorter screening intervals than the currently recommended 5 years may be appropriate for the highest risk individuals.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. j.wilschut@erasmusmc.nl
authors.forename: Janneke A
authors.initials: JA
authors.lastname: Wilschut
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Monique E
authors.initials: ME
authors.lastname: van Leerdam
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
mesh_terms: D000367:Age Factors; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000235:genetics*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D005192:Family Health; D006287:Health Planning Guidelines; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012984:Software